Note this states that antibiotics are not effective for Bart in most cases!
Clinical signs
In humans, the incubation period in humans is usually three to 10 days, but may be as long as 20 days.
In immunocompetent people, B. henselae causes CSD, a mild to severe, self-limiting infection. The initial skin rash, seen in 25%-90% of patients, consists of one or more small erythematous papules, pustules, macules, vesicles or ulcers at the site of inoculation. One to four weeks later, one or more lymph nodes become enlarged; soon afterward, the skin lesions disappear. The affected lymph nodes are usually painful or tender and the skin over the nodes is warm, reddened and indurated. Occasionally, the nodes may suppurate. The lymphadenopathy usually lasts for a few weeks to a few months, but in some patients the lymph nodes have remained enlarged for up to two years.
Other common symptoms are a fever, malaise and fatigue. The fever usually disappears within two weeks but fatigue may persist for weeks or months. Less often, there may be headaches, anorexia, vomiting, nausea, weight loss, splenomegaly, generalized pain or a sore throat.
Complications and atypical presentations are reported to occur in 5% to 16% of patients:
* Parinaud's oculoglandular syndrome occurs in 2%-6% of patients. This syndrome is characterized by nonpurulent unilateral conjunctivitis, conjunctival granuloma and periauricular lymphadenopathy. It usually resolves without permanent damage. * Encephalitis has been reported in 1%-7% of patients with CSD. It usually occurs two to six weeks after the classic symptoms. Patients with CNS disease may take up to a year to recover. * Cranial or peripheral nerve involvement may include myelitis, optic neuritis with transient unilateral blindness, facial nerve paresis or transient peripheral neuropathies. Patients with myelitis can be extremely weak, with abnormal reflexes, sensory loss and sphincter dysfunction. * In people with existing heart valve abnormalities, B. henselae bacteremia can result in endocarditis. * Disseminated disease occurs in fewer than 1% of patients. The usual signs are a persistent spiking fever, hepatosplenomegaly and abdominal pain. * Other reported complications include transient nonspecific maculopapular or nodular rashes, thrombocytopenic purpura, osteolytic lesions, arthritis, synovitis and pneumonia.
B. henselae can also cause bacillary angiomatosis (epithelioid angiomatosis), a vascular proliferative disease of the skin and/or internal organs. This can occur in immunocompetent people, but is most often an AIDS-related disease. The most apparent symptoms are one to hundreds of cutaneous papules and nodules, varying in size from pinhead-sized to 10 cm in diameter. These should be differentiated from granulomas, Kaposi's sarcoma (violaceous nodules) or lichenoid violaceous plaques. Bacillary angiomatosis can involve the internal organs, including the heart, brain, liver, spleen, larynx, lymph nodes and gastrointestinal tract.
As mentioned, B. henselae has been found in patients with FUO. It also causes Peliosis hepatis, a rare condition that may also be caused by other pathogens, drugs and toxins and is characterized by multiple blood-filled cysts and sinusoidal dilatation in the liver. Peliosis hepatis can be seen in some patients with bacillary angiomatosis.
B. henselae infections do not seem to be transmitted person-to-person by casual contact. Diagnostic tests and treatment
B. henselae infections can be confirmed by culture of the organism, PCR or serology.
Isolation of B. henselae is difficult, but may be accomplished using specialized media. PCR can differentiate B. henselae from B. quintana, the other cause of bacillary angiomatosis.
Serologic assays include an indirect immunofluorescence assay and enzyme-linked immunosorbent assay (ELISA).
Cross-reactions occur with other species of Bartonella. Cross-reactions have also been reported with other organisms including Chlamydia spp. and Coxiella burnetti.
Although B. henselae is sensitive to a number of antimicrobials in vitro, antibiotics are not consistently effective for cat scratch disease.
In contrast, bacillary angiomatosis caused by B. henselae usually responds well to antibiotics.
Arnon Shimshony, DVM, is Associate Professor at the Koret School of Veterinary Medicine Hebrew University of Jerusalem, Rehovot, and is the ProMED-mail Animal Diseases Zoonoses Moderator. Dr. Shimshony was Chief Veterinary Officer, State of Israel, from 1974 to 1999.
Posted by lou (Member # 81) on :
This covers B. henselae. There are other bart species, finding more all the time that cause disease. Wonder if there are differences in response to treatment and in symptoms?
Posted by bcb1200 (Member # 25745) on :
I would restate that it says treatment is not "consistent."
I know many on lymenet who were able to kick Bart. I plan on being one of them!